Interventional neuroradiologists perform world’s first brain aneurysm surgery on awake patient

Interventional neuroradiologists at Barts Health have performed the world’s first successful brain aneurysm surgery with a Woven EndoBridge (WEB) device while a patient was awake.

A patient was rushed to A&E at The Royal London Hospital after suffering from a headache and stiff neck for 72 hours. It was suspected that she had a ruptured brain aneurysm and was referred to the neurosurgical team. 

Investigations showed the patient would need surgery using a WEB device to stop the aneurysm from rupturing again – a treatment performed by interventional neuroradiologists at the hospital.

A WEB device is a tiny, super-soft, cage-like device that is implanted into aneurysms to stop blood flowing into it and prevents the aneurysm from rupturing.

Typically, this procedure is carried out under general anaesthetic in order to prevent the patient from moving during the operation.

However, the patient was at high risk of cardiac and pulmonary complications from the general anaesthetic. There were also concerns that she would need post-procedural respiratory support and would, in the worst-case scenario, require prolonged ventilation on the intensive care unit. 

The team took the decision to use local anaesthetic instead. They gently fixed the patient’s head using straps and prepared the equipment and medication to switch over to general anaesthetic if needed.

The aneurysm was successfully closed using only local anaesthetic without complication.  It took approximately 35 minutes and Celine was sent home seven days later. 

Dr Paul Bhogal, the consultant interventional neuroradiologist who operated, said: “Ruptured aneurysms are often smaller than 5mm and even a 1mm error can result in catastrophe.”

“Performing this treatment was stressful but I had an excellent team around me and Celine was an exceptional patient who stayed perfectly still during the procedure.”

In light of this success, the journal Interventional Neuroradiology has published a report on the procedure, recommending local anaesthetic be used in future cases where patients are similarly at risk.